Greensand House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our assessment of this key question, we found concerns around the management of risk which resulted in a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. We found risk assessments were not always detailed or up to date with the most accurate information on people’s needs. Robust action was not always taken to reduce the risk of falls. There were sufficient numbers of staff on the floor however on one floor they were not always deployed effectively. People were protected from the risk of abuse. The process around the recruitment of staff was robust.

This service scored 16 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they knew what actions to take when an incident occurred. One member of staff told us, “I would go and tell someone first and then if I have seen something, I would then record it.” Staff told us they would be updated on any changes made to care as a result of incidents occurring. One told us, “There is so much communication in the home. The managers will tell us things at handover, through supervisions and emails.”

People were at risk as actions taken to reduce falls were not always effective to prevent further occurrences. This particularly related to people at risk of falls. We saw from the analysis falls report for October and November 2023 that multiple unwitnessed falls occurred on the top floor. Whilst the actions identified was for handovers and staff breaks to be staggered to ensure people were supported; we saw the same concern remained for the falls reported for December and January 2024. Since the same action was noted, appropriate action had not previously been completed to mitigate further risks to people who continued to have falls which at times resulted in injury.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff understood what they needed to do to protect people from the risk of abuse. One member of staff told us, “We are always checking on people and if we notice a mark, we ask about it, if we notice a change in mood, we ask them about it. We report it immediately and keep taking it higher to make sure action is done.” Another told us, “I keep myself aware and seeing what’s going on. If I wasn’t sure on something I would tell someone about it. I haven’t seen anything to be concerned of.” The manager told us, “I like to speak to the residents to reassure I have looked into [safeguarding concerns], what we have done and where we are with investigations. I want them to know that I have looked into [concerns] and give feedback and that I will do something about it."

We observed that staff were vigilant when people showed anxiety and stepped in to ensure people’s anxiety was not directed towards other people that were around them. Staff received safeguarding training and there was a whistleblowing policy that staff could access. Where there was a safeguarding concern, this was raised with the local authority and a full investigation was undertaken.

People told us they felt safe with staff. Comments included, “The staff keep us safe by always checking in” and “It is very safe here, I feel staff will help me with everything.” Relatives fed back they felt their loved ones were safe and well looked after. Comments from them included, “I have total faith the staff keep Mum safe in every way possible” and “It feels me with confidence knowing [family member] is here…. she is well looked after.” We observed people looked relaxed and comfortable within the presence of staff.

Staff were able to give a good account of the risks associated with people’s care and how best to support them. When asked about how the frequency of falls could be reduced, 1 member of staff told us, “We need to ensure the corridors are left clear, this will help prevent falls. Sometimes it could be the shoes so may encourage them to wear more secure shoes instead of slippers.” Another member of staff told us of risks, “You always keep your eyes open so to speak. Some people have very dry skin, I would take note and observe and tell the person. Report it to the senior care. They have their creams to apply. With weight loss, we do the weekly weigh in, we have these milkshake protein drinks. Encourage snacks and drinks.” The manager told us, “All the risks are assessed with mitigations, we are constantly asking questions. Every day we have a 10 at 10 meeting and all the team leaders and ‘Head of Departments’ come in so we can go over any current risks.”

Staff ensured that people had their walking aids within reach. Where needed, people had pressure mattresses in place to reduce the risk of pressure sores. We observed people being given fortified snacks and meals where they were at risk of malnutrition and staff regularly encouraged people to drink.

Assessments that were undertaken to identify risks to people and protect them from harm were not always detailed and at times lacked guidance. For example, 1 person had been diagnosed with a mental health condition however there was a lack of detail around how this affected the person or how staff should support them with this. Another person showed high levels of anxiety when receiving personal care but there was a lack of guidance for staff on how best to support them with this before resorting to using anti-psychotic medicine to calm them. Risk assessments were not always updated after a person had fallen and there was contradictory information around people’s mobility needs. For example, 1 person had suffered 3 falls since May 2023. Their risk assessment stated they required a wheelchair as they were no longer able to walk distances. However, their mobility risk assessment stated they walked independently without the need for any walking aids. This meant there was a risk staff who did not know the person would not provide the safest care. Other risk assessments provided guidance to staff about the risk, action to take to minimise the risk and how to support people. These included the risk of dehydration, malnutrition, skin integrity and wound care. These risk assessments were regularly reviewed and updated where needed.

People told us they felt the risks associated with their care were managed well by staff. One person told us, “The staff keep us safe; they help us move around whenever we want to, so they stop me falling.” Another told us, “The staff are very good, and the building is very secure with key codes and the rest.” Relatives felt staff were knowledgeable of the risks with their loved one’s care. Comments included, “I think she is looked after better here” and “[Person] is happy and safe; it is like a hotel there.”

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We observed on the top floor staff were not always deployed effectively to ensure people received safe care. When we arrived on the top floor in the morning, 1 person, who was at risk of falls, had been left on their own in the lounge for 10 minutes before we raised this with a senior member of staff. Another person wanted to go downstairs but this was delayed as there were not sufficient staff to support them with this. Although 3 staff had been rotered to work on the floor, 1 member of staff spent the morning downstairs with another person, leaving the floor short of staff. On the ground floor we found people were being supported when needed. When call bells were used staff responded quickly and staff did not appear to be rushed. During lunch on both floors people had the support needed from staff.

The provider operated effective and safe recruitment practices when employing new staff. This included requesting and receiving references and checks with the disclosure and barring service (DBS). DBS checks are carried out to confirm whether prospective new staff had a criminal record or were barred from working with vulnerable people. The provider ensured where there was staff absence this was appropriately covered by including the use of regular agency staff. The provider regularly reviewed the needs of people to ensure they had sufficient staff to support them in a safe way.

There were varying responses from staff on whether there were sufficient staff on shift. Comments from staff working on the top floor included, “2 carers and 1 team leader is not enough, for example, we start at 08.00, we didn’t have breaks. We need more staff so we could spend more time with [people]. People can’t go downstairs as often as they would like [as a member of staff was needed to go down with them]” and “I don’t think there are enough staff, it’s hard because each day is different. Impact is that we are rushing a bit, not spending time with them.” Staff on the ground floor fed back there were sufficient staff on duty with comments including, “They have staff numbers we can call and an agency. Since I’ve been here, we have regular agency that do know the residents well” and “We call around, shifts will always get covered.”

Most people fed back there were enough staff to support them in a safe way. On the ground floor comments from people included, “I’ve never felt rushed” and “The staff are all very calm and always have time for you.” Relatives fed back, “There’s always staff if she needs them and also for us to talk to when we’re here” and “I’ve never seen the staff here in a rush at all. They always seem calm.” However, 1 person on the top floor told us, “Often I can’t find staff. The staff are good and do their job well, but they are short on staff.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.